Insurance Handbook Chapter 5- Diagnostic Coding

If documentation states that the incident related to a poisoning was a suspected suicide attempt, the code would be reported from the column titled ________.

"Undetermined"

A condition that is produced after the acute phase of an illness is listed as the main term _______ in the Alphabetic Index.

"sequela"

The instructional note _________ listed in the Tabular List assists the coder as to when it is appropriate to report a secondary code.

"use additional code"

When reporting a condition that affects the left side of the patient, the character ______ is reported to indicate laterality.

2

When selecting a code that corresponds with the condition stated in the medical record, the coder should first locate the term in the __________ and then confirm the code in the __________

Alphabet Index, Tabular List

_________ are used to enclose synonyms in the Tabular List.

Brackets

Because there are annual ICD-10-CM code revisions, there is a 3-month grace period to implement these changes and revisions.

F

Diagnoses that relate to the patient's previous medical problem must always be reported.

F

ICD-10 was published by the WHO and clinically modified by CMS.

F

The concept of "principal diagnosis" is applicable to outpatient and inpatient cases.

F

The diagnosis coding system is designed to provide statistical mortality rate data that include information about causes of diseases.

F

ICD-10-CM is the standard code set required under ______ legislation and must be used by covered entities when assigning diagnostic codes.

HIPAA

The abbreviation ICD-10-CM means _______________

International Classification of Diseases, Tenth Revision, Clinical Modification

__________ hypertension is indicative of a life-threatening condition.

Malignant

When coding for diabetes in pregnancy, a code from category _______ is assigned as the primary diagnosis.

O24

Diagnosis coding for the services provided by a physician are reported using ICD-10-CM effective with dates of service _____________

October 1, 2014

An external cause code may never be sequenced as the primary diagnosis in the first position.

T

Code conventions are rules or principles for determining a diagnostic code when using a diagnostic code book.

T

ICD-10-CM codes can contain up to seven characters.

T

Signs and symptoms that are not typically associated with a disease process should be reported when documented.

T

The Alphabetic Index contains the Table of Drugs and Chemicals.

T

The process for looking up a diagnosis code in the ICD-9-Cm coding system is the same as in the ICD-10-Cm coding system.

T

When a person who is not currently sick encounters health services for some specific purpose, such as to receive a vaccination, then a Z code is used.

T

ICD-10-CM is the coding system for reporting inpatient services by hospitals and replaces _________ of the ICD-9-CM coding system.

Volume 3

The official version of the International Classification of Disease was developed by the ________

World Health Organization

When using the ICD-10-CM coding system, the ______ is used as a placeholder to save space for future code expansion.

X

When a person encounters health services to receive a vaccination, the diagnosis is reported with a ____________.

Z-code

When two diagnoses are classified with a single code, it is referred to as:

a. combination code

When fractures are determined, but there is no indication of whether the fracture is open or closed,

a. report as closed.

Diagnosis codes should be reported to the highest level of:

a. specificity

Volume 2, Disease, is a/an ________ index or listing of code numbers.

alphabetic

To determine the diagnosis codes that would support medical necessity of a specific procedure such as an MRI under Medicare guidelines, the coder should consult:

b. LCDs and NCDs

The equivalent of unspecified is:

b. NOS

External cause codes are used to:

b. establish injury prevention programs.

The Alphabetic Index to Diseases and Injuries is placed:

b. first in the coding manual.

When a provider makes a hospital visit, the encounter should be reported with a diagnosis code that represents:

b. the condition the provider evaluated and treated during the encounter

When identifying the total body surface area of a burn, the front torso is considered as:

c. 18%

When reporting an encounter for testing of HIV, the code should be assigned as:

c. Z11.4

When reporting laterality, the final character "3" is reported to indicate:

c. bilateral

Annual updates to ICD-10-CM are published:

c. by the AHA, AHIMA, and U.S. Printing Office.

An essential modifier is also referred to as a:

c. subterm

When conditions documented as "threatened" are referenced for the Alphabetic Index and there is no entry for the threatened condition, report:

c. the existing underlying condition

Signs and symptoms are acceptable for reporting purposes:

c. when a definitive diagnosis has not been determined.

How many chapters does the Tabular List contain?

d. 21

ICD-10-PCS (Procedure Coding System) was developed by 3M Health Information Systems under contract with the:

d. Centers for Medicare and Medicaid Services

Passage of which legislation, in 1988, placed requirements on physicians to report appropriate diagnosis codes on all claims to Medicare?

d. Medicare Catastrophic Coverage Act

GEMs is a common translation tool used to:

d. a and c -convert ICD-9-Cm codes to ICD-10-Cm codes -convert ICD-10-CM codes to ICD-9-Cm codes

The consequences of inaccurate assignment of diagnostic codes include:

d. all of the above -delay in payment of claim. -denial of claim. -change in level of reimbursement.

If a condition is documented in the medical record, but it is not specified as to whether the condition is acute or chronic, the the _____ code should be assigned.

default

If a patient falls and fractures his or her wrist, the fracture code is the primary code, followed by a/an ___________ code to explain how the accident occurred.

external cause

ICD-10-CM requires ________ documentation in the medical record than the previous coding system, ICD-9-CM.

greater

The neoplasm table has column headings for ______ , _______, _________, and _________.

malignant, benign, uncertain behavior, unspecified

Claims to insurance carriers often are denied because of lack of _______ which indicates that the procedure provided was not payable for the diagnosis submitted.

medical necessity

The abbreviation NEC appearing in the ICD-10-CM code book means _______

not elsewhere classifiable

Additional external cause codes are _________ when reporting poisonings using combination codes from T36 through T65.

not required

In juvenile diabetes, the patient's _________ does not function anad produce enough insulin.

pancreas

Insurance carriers keep _______, which are a compilation of statistics regarding services and payments made to the physician over a period of time.

physician fee profiles

When submitting insurance claims for patients seen in a physician's office or in an outpatient hospital setting, the ______ diagnosis is listed first, but in the inpatient hospital setting, the ______ diagnosis is used.

primary , principal

Conventions are ____ used in the diagnostic code books to assist in the selection of correct codes for the diagnosis encountered.

rules or principals

Volume 1, Diseases is a/an ______ listing of code numbers.

tabular or numerical

When reporting accidents and injuries, a seventh character of "A" identifies that the encounter is ________________.

the initial encounter

Full-term uncomplicated _________ deliveries are always reported with the code O80.

vaginal